Problem: You and your colleague Gavin are called to attend a male patient, Julio, who has been waiting to be transported to the local hospital for renal dialysis and a palliative care consultation.
Julio is 75 years old and has end-stage kidney failure. He who also has severe dementia. Julio lives with his wife Maria who is his carer. Julio has been ill and is two days overdue for his renal dialysis.
You arrive at 10 am to find Julio sitting restlessly next to his bed. Maria gives you an update on her husband.
Julio's dementia diagnosis was made six years ago and is he is slowly deteriorating.
Julio is Italian by birth. Maria says he has a strong Roman Catholic belief. With the onset of dementia Julio lost much of his ability to speak English and he has reverted speaking Italian, which is his first language. Maria says that Julio has been quite irritable over the past 24 to 48 hours, which she indicates is common when he is late for dialysis.
Julio is fidgeting in his chair and appears unsure whether to sit or stand. Occasionally he says something loudly in Italian. Julio also looks unwell - he is slightly pale and sweaty, he has a slight tremor in both hands.
Gavin decides to perform a set of vital signs prior to transporting Julio, but you are wary that approaching and performing the vital signs activity may meet with resistance and confusion, given Julio's current state.
Gavin approaches Julio, who begins crying out in Italian and throwing his arms around. He is clearly confused and starts to act aggressive. Following intervention and support from Maria, Gavin manages to communicate successfully about what is happening using Maria as the interpreter.
Maria is able to calm Julio enough that he can have his vitals taken. Julio's vital signs are:
BP=135/85 Heart Rate=88 Resp. Rate= 22 SaO2= 95%
Temp = 38.0C
HNPU 24/7
Other information:
A full upper and lower denture, which are ill fitting.
Glasses due to his eyesight deteriorating.
Halitosis +++ and dry crusty mouth/lips.
Nil by mouth since 7pm day previous (refusing all offers of food and water)
Frequent outbursts of difficult behaviour over past 24/48 hours
Broken restless sleep past 2/7 nights
Dozing past 2 days x 3 for 10-20 mins - waking irritable, confused and aggressive
Several skin tears to his R (3) and L (2) anterior calves that appear red angry and infected
Julio begins to play with the stretcher while you are organising it, pacing around and placing his hands on the levers and latches. He reaches under the stretcher, scratching around frantically as if looking for something. You are concerned he will get his hands caught in the stretcher and hurt himself.
You are ready for Julio to be transported to the hospital. You and Gavin approach Julio to help him on to the stretcher.
Julio suddenly shouts something in Italian and begins to wave his fists at you. In doing so, Julio accidently hits Gavin in the face. Gavin's lip starts to bleed. Maria is startled, upset and begins to cry. You reassure Maria and intervene to support Julio to calm down. Eventually he gets on to the stretcher for transport and you head to the hospital.
1. Identify the medium and high-risk measures that may be present in this case study. As part of your answer, outline at least three (3) strategies you could apply to manage, minimise or de-escalate the behaviours of concern shown by Julio (as a patient with dementia).
2. Explain why it is important to assess Julio's physical health status and what you would be looking for due to his dementia diagnosis.
3. Outline the behaviours of concern Julio exhibited and possible contributing factors.
4. Describe two (2) strategies that you could use to minimise Julio's behaviour and keep himself, Maria and the attending health care team safe.
5. Identify three (3) relevant human rights that need to be observed and applied when working with Julio, other patients with dementia and those from a different cultural and/or religious background. Provide a reason why you have chosen each human right.